All psychiatrists should read this book. All psychiatrists-in-training should read this book. Any and all mental health professionals will profit from Dr. Nesse’s volume.
Surgeons have long possessed an accurate anatomy of the human body. Psychiatrists lacked a basic anatomy of human nature to understand the emotional illnesses that arise from it. Now we have a substantial anatomy of human nature thanks to the application of Darwin’s great idea to the mind. Even though Darwin foresaw that psychology would be based on a new foundation, a century and a half elapsed before his idea was systematically applied to psychology and social relations. The advent of evolutionary psychology stands as one of the great intellectual revolutions of all time. The mind is what the brain does and evolved under the rules of Darwinian natural selection. Randy Nesse was one of the first psychiatrists and certainly is the most important one to see the centrality of evolution for psychiatry and medicine.
There are many strengths to the book. Dr. Nesse structures the narrative arc with his personal professional journey. Any mental health professional will identify with this. How does one understand the nature and causes of the suffering that daily confront us as clinicians? How do we treat patients and effectively reduce or relieve suffering? What theoretical framework best explains the facts before us? What treatment modalities give us a running chance at success? To fix a broken leg you need to know its anatomy. Now we have that anatomy. The mind is shaped by natural selection. Our emotions are designed for our genes’ interests, not our individual self-interest.
All of the problems that we see as mental health professionals are addressed. No matter what area a clinician reader might focus on, Randy Nesse teaches valuable lessons.
One of the most important lessons we learn from him, which our profession still has failed to master, is that we confuse adaptive defenses with disease. We continue to conceptualize and medicate the phenomena of anxiety and depression as illnesses that float free of the individual’s unique life experiences and the evolved structure of the mind.
Any mental health provider will be familiar with the failure to find genes specific to the illnesses we treat. A Huntington’s disease model of one malfunctioning gene will never bail us out. We now know that the risk alleles for the major mental illnesses are numerous and probably there for other good evolutionary reasons. So how do we comprehend the devastating diseases like schizophrenia and bipolar illness? Dr. Nesse’s application of “cliff edge fitness landscapes” to severe mental illness illustrates his perseverance and brilliance. He utilizes the tools of evolutionary biology to comprehend the devastating diseases we treat. I’ll explain ‘cliff edge’ no further. Read the book to learn this idea. You will be rewarded.